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Contact Information

JACOB E PETERSON, MD, MBA
79 WAWECUS ST STE 103
NORWICH, CT06360-2173
 Phone: 860-886-1862
 Fax: 860-886-2046
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pulmonary Disease

207RP1001X 11 Physician/Internal Medicine
 

General Practice

208D00000X 99 Physician/Undefined Physician type[6]
 

Hospitalist

208M00000X
 

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Student in an Organized Health Care Education/Training Program

390200000X
Indicates primary specialty

NPI Profile & details for JACOB E PETERSON · (Male)

NPI Number 1295196384
Status Active
Credentials MD, MBA
Entity Individual
Enumeration date 03/16/2016
Last updated 02/12/2026 - About 4 months ago
Sole proprietor 1 No
Identifiers
  • CT License # 76208
  • VA License # 0101263068
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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